CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Samaritan Hospital of Troy, New York

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $34,895
Cash Discount Price: $21,719
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Samaritan Hospital of Troy, New York is $34,895. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,719. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.48x the Medicare baseline. Located in 2215 Burdett Avenue, Troy, NY.

Cash / Self-Pay

$21,719

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,895

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $21,719 (92%)

Insurance Median: $34,895 (148%)

Cash: $21,719 (92% of Medicare)

Ins. Median: $34,895 (148% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Wellpath	$3,000	13%
Blue Cross Blue Shield	$30,533 - $31,156	130%
Medicare (plans)	$31,143 - $34,807	133%
Eddy Seniorcare Pace	$31,156	133%
Secure Horizons Ma Pffs	$31,754	135%
UnitedHealthcare	$31,754 - $115,813	135%
Aetna	$32,975 - $69,412	140%
Medicaid / KanCare	$33,025	141%
Hudson Headwaters Pace	$33,648	143%
Nascentia Health Plus	$34,895	148%
Fidelis Care	$56,081	239%
1199 National Benefit Fund	$69,412	295%
Allied Benefit Systems	$69,412	295%
Asr Health Benefits	$69,412	295%
Christian Brother Services	$69,412	295%
Geha	$69,412	295%
Lucent Health	$69,412	295%
Luminare Health	$69,412	295%
Medical Mutual	$69,412	295%
Meritain	$69,412	295%
Trustmark Small Business Benefits	$69,412	295%
Capital District Physicians Health Plan	$89,327	380%
Emblem Health	$89,779	382%
Nova	$89,779	382%
Harvard Pilgrim Healthcare	$115,813	493%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $21,719.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Samaritan Hospital of Troy, New York is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 451.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.